Grief and Loss

Overview of the grieving process

Grief is a natural human response to the loss of a loved one. It can show itself in many ways. Grief moves in and out of stages from disbelief and denial, to anger and guilt, to finding a source of comfort, to eventually adjusting to the loss.

It is normal for both the dying person and the survivors to experience grief. For survivors, the grieving process can take many years and many forms. The challenge of accepting death and dying as the end stage of life is what the grieving process is all about.

What is anticipatory grief vs. sudden loss?

Anticipatory grief. This happens when someone has a prolonged illness, and the patient as well as the family anticipates death. Anticipating the loss of a loved one can be just as painful and stressful as the actual act of losing that person. Anticipatory grief allows the family to prepare for the inevitable death. This can be a time to resolve issues and concerns, and seek the support of spiritual leaders, family, and friends. It is also a time to clarify the loved one's wishes for funeral and burial arrangements and other end-of-life issues.

Sudden loss. This is a death that happens unexpectedly and suddenly, like a fatal accident or heart attack. Such tragedies can leave survivors feeling shocked and confused. Loved ones are often left with many questions, unresolved issues, and a range of emotions, including anger, guilt, and pain. Support from family, friends, and clergy is important to people experiencing sudden loss.

What may happen in the case of anticipated death?

Many, although not all, people facing their own death are willing to discuss issues of death and dying. This can be a time to discuss spiritual issues, resolve family concerns, reflect on a loved one's life and accomplishments, and express gratitude. It also provides an opportunity to put practical matters in order, including the following:

Can funeral expenses be prepaid?

Which funeral home would the person prefer to handle arrangements?

Can the person assist with obituary information to make sure it is accurate and complete?

What are the individual's specific funeral wishes?

If a church service is in order, can the person facing death help plan favorite Scripture passages or hymns?

Is cremation or burial preferred?

Has a cemetery plot been purchased?

Does the person wish for memorial contributions to be made to a particular charity or benevolent organization?

What are the symptoms of grief?

For both the person facing death and survivors after the death of a loved one, it is natural to experience many symptoms of grief. These can include:

Physical symptoms:

Lack of energy or fatigue

Headaches and upset stomach

Excessive sleeping or overworking and excessive activity

Emotional symptoms:

Memory lapses, distraction, and preoccupation

Irritability

Depression and feelings of euphoria

Extreme anger or feelings of being resigned to the situation

Spiritual symptoms:

Feelings of being closer to God or feelings of anger and outrage at God

Strengthening of faith or questioning of faith

What are the different stages of grief?

It is natural for people who are facing death, as well as those they leave behind, to move through many stages of grief. For survivors, the grieving process can last for several months or for 2 to 3 years or more. The stages of grief do not necessarily fall into a set order, and vary greatly from 1 individual to another. People may move in and out of these stages at different times throughout the grieving process. These stages include:

Shock

Depression, loneliness, and a sense of isolation

Physical symptoms, such as headaches, body aches, or stomach distress

Feelings of panic

Guilt

Anger

Inability to return to daily routine

Return of feelings of hopefulness

Acceptance

If you or a loved one is experiencing a grieving period that seems to last longer than it should, you may want to seek professional counseling to assist you through the process. Your healthcare provider may be a good referral source, or you may want to speak with your spiritual leader (like priest, rabbi, and minister) for advice.

When providing support for the bereaved

There are many things you can do to assist a bereaved person. These include:

Sending cards or flowers

Preparing food

Providing child care

Mowing the lawn

Contributing to a cause which is meaningful to the family

Offering transportation

You may also consider the following when providing for the bereaved:

Be available. Sometimes, when people are grieving, they do not want to talk or listen, nor do they want you to talk or listen. They simply want you to be there for them.

Allow the grieving person the full range of his or her emotions, including anger and bitterness, which may sometimes be expressed against the healthcare providers, God, or even the loved one who has died.

Be patient and understanding, but not patronizing. Do not claim to know how the other person is feeling. Do not force the person to talk or share feelings if he or she does not want to.

Do not be concerned about mentioning the deceased person's name or sharing a fond memory of the person while in the company of the bereaved. They, too, are thinking about their loved one, so it is acceptable and natural to bring the name into conversation.

Remember that grieving takes time and is a natural human process. No matter how much you want to "stop the hurt," the bereaved must endure the grieving process. Allow them time and care for them as they move through it.

A person who is grieving for over 1 year should be evaluated by a healthcare provider.

Abnormal bereavement

The primary healthcare provider can help the bereaved person adapt to his or her loss. Even though they may experience ill health, people with abnormal bereavement are less likely to use health services. Outreach efforts are important to help those in need of these services. Depression, suicide, anxiety, and complicated grief are the most common negative psychological traits associated with loss.

Caring for the bereaved after the death

A healthcare provider caring for the deceased can help the bereaved accept the death by doing the following:

The healthcare provider should contact family members not present at the bedside immediately after the death to tell them about their loss, express sympathy, answer questions, and offer them the option of viewing the body.

A condolence letter is an important part of quality end-of-life care. Consider attending the funeral or memorial service.

The United States Preventive Services Task Force recommends that healthcare providers be aware of suicidal thoughts in people who have had a recent loss. Since the bereaved often do not initiate contact, it is advisable to reach out to the bereaved through a personal phone call or an appointment.

Patients adapt faster to the loss if they keep up with their regular patterns of activity, sleep, exercise, and nutrition and should be encouraged to do so.

Most people who are grieving turn to family, friends, and religious organizations. Bereaved people who do not have such social supports in place turn to a healthcare provider as an outlet for their grief.